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    Christian Green
    Christian Green, MA

    By Christmas week 2021, Omicron had become the dominant COVID-19 variant in the United States, and cases nearly quintupled over the past month. On Monday, the U.S. seven-day daily COVID-19 case average topped 700,000 for the first time — a number that doesn’t include positive home antigen results.  
    To put the Omicron surge in perspective, the 4.91 million cases reported during the seven-day period ending last Saturday were more than those reported in April, May, June and July 2021 combined.
    As a result, nearly a quarter of U.S. hospitals are reporting a "critical staffing shortage," according to the Department of Health & Human Services, many of which have had to turn away patients. Omicron has also affected first responder times in some cities, increased staff and student absences from school, and disrupted staffing throughout the service industry.
    But has the surge kept patients away from the doctor’s office, setting the stage for more virtual visits?  

     A Jan. 11, 2022, MGMA Stat poll found that 45% of medical practices said they shifted to more telehealth/virtual visits amid the latest COVID-19 surge, while 55% responded that they had not. The poll had 754 applicable responses.
    For those who said they were offering more telehealth/virtual visits, safety was the primary reason, followed closely by staffing and then patient demand. However, many reasons were linked, as practices work hard to meet patient needs while also helping to keep their communities safe:  

    • “It's a combination of staffing issues and the effort to keep COVID out of the office. We've gone from approximately 8% to 10% telehealth visits to [more than] 50%.”
    • “Staffing issues. Patient demand is massive. Patients want to get taken care of and if they have COVID we prefer virtual visits with adult medicine patients. PEDS patients we see in person.”
    • “Staffing issues; more out sick either themselves or family members. Patients still don't want to come in to the office. Physicians are so busy with increased hospital admissions.”
    • “Safety, to minimize community spread of Omicron variant, staffing shortages, and also to help keep acute sick patients overwhelming our ERs with non-emergency issues (patients demanding covid testing in ERs).”

    For those who responded that they weren’t offering more telehealth/virtual visits, their biggest challenges during the Omicron surge included:

    • Lack of COVID-19 test kits
    • Shortage of personal protective equipment (PPE)
    • Scarcity of supplies in general.  

    In regard to supply shortages, respondents noted:

    • “Numerous back orders for PPE supplies (gowns, masks). Also, rapid COVID tests are on back order and allocation.”
    • “PPE is OK; it's saline and flushes that we are having issues getting.”
    • “Some general supply shortage/delivery issues due to people out with COVID.”


    The ebb and flow of telehealth utilization

    Telehealth growth was unprecedented in 2020, but as patients returned to the doctor’s office in 2021, virtual care waned significantly. According to a report last month by analytics firm Trilliant Health which examined commercial, Medicare Advantage and Medicaid managed-care claims, overall telehealth utilization experienced a precipitous decline in 2021 compared to 2020. When analyzing all payers, on average telehealth use decreased by more than 40% a month in 2021.
    Despite the overall decline of telehealth utilization in 2021, medical practices have continued to acknowledge its importance. As documented in the Oct. 19, 2021, MGMA Stat poll in which 70% of practice leaders said telehealth would either stay the same or increase in 2022, telehealth is viewed as a vital resource to ensure patients have access to care and to maintain continuity of care, while also providing convenient and efficient care to patients.
    During COVID-19 case spikes, such as the Omicron surge, telehealth has served to reduce patients’ and providers’ risk of coronavirus exposure, as well as lessen the strain on the overtaxed healthcare system. During the Delta outbreak late last summer, a Jarrard poll reported that two American adults out of five said they would use telehealth to get medical care.
    There’s also quantitative data that point to an increase in telehealth utilization during COVID-19 outbreaks. Data compiled from FAIR Health’s Monthly Telehealth Regional Tracker, which through mid-December had analyzed more than 35 billion private claims records to determine telehealth use since May 2020, suggest that utilization ebbs and flows depending on the number of COVID-19 cases in a geographic area.
    For example, in June and July 2021, telehealth use declined in the South and nationally; however, from July to August, when the Delta variant took hold, telehealth utilization increased 12.9% in the South. Additionally, in September, telehealth accounted for 4.4% of all medical claim lines, but once the Delta surge receded in October, telehealth use hit a two-year low — just 4.1% of all medical claims.

    Quality tied to the type of telehealth visit

    Telehealth is not conducive to every specialty nor every type of visit. Despite its tremendous growth from 2019 to 2020, telehealth use for traditional medical services is relatively insignificant. For example, according to the Trilliant report, only 2.6% of Medicare Part B specialty visits and 8.3% of primary care visits during the telehealth boom in 2020 were via telehealth.
    In contrast, with high rates of depression and anxiety brought on by the pandemic, behavioral health visits have skyrocketed, representing 38.1% of all visits delivered by telehealth.  
    According to a new study by Annals of Internal Medicine, another area where telehealth visits can serve as an effective substitute for in-person visits is for chronic conditions such as diabetes, heart issues and respiratory illness.
    "The studies generally are looking at things that can be followed and evaluated at a distance," said Jordan Albritton, PhD, MPH, public health analyst with RTI International, in a U.S. News & World Report article referencing the study, adding that this doesn’t mean chronic care patients don’t need to see a physician in person.
    Although providers point out that a complete medical assessment cannot be done for new patient visits, diagnosing new illnesses or providing preventive care via telehealth, virtual care has been a means to keep patients, providers and staff safe; meet patient demand during COVID-19 surges; and address staffing issues. As one MGMA Stat poll respondent succinctly put it, “We are able to reach more patients that need us in a safe manner,” which is all anyone can ask for during these trying times.
    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit Polls will be sent to your phone via text message. 
    Additional resources 

    Christian Green

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